Abstract [en]

Background: It may be argued that the purpose of the health care sector is toachieve as much health as possible with the available resources. Cost-effectivenessanalysis with Quality-Adjusted Life Years, QALYs, as a measurement is used forevaluating the value of treatments in health care. But the purpose of health care canbe more than maximizing health (efficiency). If so, distribution of health may also beconsidered when allocating scarce resources. This can be achieved by incorporatingseverity of disease into decision making alongside effectiveness. In this thesis weinvestigate need for different diseases. Three methods for quantifying need wereconsidered; Fair Innings, Absolute QALY Shortfall and Proportional QALY Shortfall.Today there are only a few studies available that has investigated these methodsempirically. This study will use data from available economic evaluations to quantifythe need.Aim: The aim of this study is to quantify and compare the required level of need fortwo different diseases, and investigate how the choice of method affects the estimatedneed. Furthermore, the aim is to highlight and discuss the ethical and practicalimplications for priority decisions made in health care based on effectiveness andneed.Methods: In order to quantify need with the three methods, the total expectedQALYs were calculated for two different disease groups and the normal population.The total amount of QALYs was calculated based on decision-analytical modelsestimating disease progression, mortality data from SCB and quality adjustmentweights from a larger cross- sectional study. The difference between QALYs in thedisease groups and the normal population is the quantified need.Conclusion: Individuals born in Sweden today can expect about 70 years of fullhealth during their lifetime. The degree of need depends on chosen method. Theprioritizing order is the same for all methods, except for Proportional QALY Shortfallthat gives higher priority to the elderly. Implementing these methods in decisionmakinghas to take the ethical platform into consideration and the current studyaddresses issues associated with this.